A Guide to Your Day Case Procedure

Thank you for choosing The Private Clinic.

On this page you will find guidance to help prepare you for your upcoming surgery.

Please take your time to familiarize yourself with the content which provides general information on preparing for your surgery and thereafter.

Contents     

1. Preparing for your Surgery & Anaesthesia

2. Day of Surgery

3. Aftercare & Post-op recovery

4. Providing Feedback

1. Preparing for Surgery & Anaesthesia

Types of Anaesthesia

Whilst some procedures at our Fitzrovia Hospital may be completed under local anaesthesia, with no sedation at all, procedures that require general anaesthetic or sedation are performed using TIVA (Total Intravenous Anaesthesia) administered by our Consultant Anaesthetists.

TIVA Anaesthetic

TIVA has some advantages over the use of anaesthetic gases and is preferential in daycase surgeries. Avoidance of anaesthetic gases can reduce the risk of nausea and vomiting after surgery and TIVA is also associated with a quicker recovery time. TIVA has the added advantage of being more environmentally friendly.

Patients should note that when they have a surgical procedure, factors other than anaesthesia can increase the risk of nausea and vomiting afterwards. For example, certain types of procedures are associated with an increased incidence of nausea and vomiting. In addition, some people are more prone to this.

Local Anaesthetic

Local anaesthesia only numbs a small part of the body where you are having the operation. It is used when nerves can be easily reached by drops, sprays, ointments or injections. You stay alert and awake throughout, but free from pain. Occasionally, you may feel some discomfort and the surgeon may have to apply a top-up of local anaesthetic. Common examples of surgery using local anaesthetic are minor procedures, endo venous laser ablation for varicose veins and some bunion surgery.

Conscious sedation

Conscious sedation uses a mild sedative to relax you and an analgesic to relieve the pain, which is given through a vein (intra-venously). You will be talking, aware of the procedure but may not remember afterwards. You may drift off to sleep at times but will be easy to wake.

Deep Sedation

Deep sedation uses a sedative to relax you and an analgesic to relieve the pain, which is given through a vein (intra-venously). You won’t be talking, may be aware of the procedure but unlikely to remember. You will likely fall asleep, but you will respond to voice and able to follow simple directions. The anaesthetist can control the depth of sedation, according to the circumstances or part of the operation.

General Anaesthetic

General anaesthesia is also given intravenously, this affects your whole body. You will be unconscious, and your body will be immobilised. You will not feel pain and have no memory of the procedure afterwards. General anaesthesia is used for most surgical procedures where it’s safer or more comfortable for you to be unconscious, including breast and abdominoplasty surgery.

Side effects of Anaesthesia

Most side effects happen immediately after your operation and do not last long. Possible side effects include:

  • Nausea & vomiting (but unusual with TIVA) – this usually happens immediately, although some people may continue to feel sick for up to a day.
  • Shivering and feeling cold – this may last a few minutes or hours.
  • Bruising and soreness – from the cannula (plastic tube) in your hand; which usually heals without treatment.
  • Dizziness, faintness or headache – tends to occur in specific patients or when dehydrated.
  • Bladder problems – you may have difficulty passing urine. You will be required to pass urine before discharge if you had a general anaesthetic.
  • Sore throat – After a general anaesthetic as a breathing tube has been inserted in your throat to help you breathe during the procedure.
  • Damage to the mouth or teeth – After a general anaesthetic, a small proportion of people may have small cuts to their lips or tongue from the breathing tube. Damage to teeth is unlikely unless you have crowns or loose teeth. Your anaesthetist will assess this and discuss the risks with you beforehand.

Complications and Risks

A number of more serious complications are associated with general anaesthetics, but these are rare.

Possible serious complications and risks include:

  • A serious allergic reaction to the anaesthetic (anaphylaxis) – Minimised by providing an accurate medical history.
  • Injury to the skin, nerves, eyes and joints – We will protect and pad your skin and eyes throughout the procedure.
  • Waking up during your operation (accidental awareness) – Continuous monitoring throughout by the anaesthetist means this is extremely rare.
  • Thromboembolism (clots in the legs and lungs) – Minimised with stockings, boots and anti-coagulation medications.
  • Heart attacks & strokes – normally restricted to those with previous history.

Serious problems are minimised by identifying individual patient issues during the consultation and pre-operative assessment processes. Your anaesthetist will review your records pre-operatively and may request additional tests/clarification, to ensure your safety prior to progressing with the surgery.

Further information regarding anaesthesia can be found on the Royal College of Anaesthetics website.

Pre-operative preparation

Prior to your surgery date you should follow the below guidance to ensure anaesthetic safety and optimal healing. Please note that failure to follow the advice given may result in cancellation of your surgery.

  • Keep as active as possible. Fitter patients recover quicker and experience fewer complications.
  • You must follow the fasting guidelines given.
  • You must not drink alcohol for at least 48 hours prior to your scheduled surgery as it may interfere with your anaesthetic and affect bleeding.
  • You must stop taking recreational drugs as these may interfere with anaesthesia.
  • You must have given up smoking (this includes all forms of nicotine: gum, vapes and passive smoking) for a minimum of two weeks prior to surgery, or more as advised by your surgeon. Smoking reduces the amount of oxygen in your blood and increases the risk of breathing and heart problems during and after the operation. Your surgical wound may heal more slowly and may be more likely to get infected if you smoke. Failure to follow the guidance on this may mean that your procedure is cancelled on the day, and you may incur a financial penalty. Please refer to our Terms and Conditions.
  • Please stop certain medications if advised to do so by your surgeon.
  • If you have recently been prescribed a course of antibiotics, you will need to have finished the course at least 4 weeks before your date of admission if having implant surgery. Please advise your nurse if you have or are currently taking antibiotics.
  • Advise your nurse if you think you may be pregnant, at the earliest opportunity.
  • Should you develop a cough, cold or flu symptoms or feel generally unwell prior to surgery, please contact your Patient Care Coordinator.
  • Keep your skin in optimal condition. One of the many functions of the skin is to act as a barrier to infection. Infected eczema, psoriasis, or other open wounds could lead to an operation being cancelled on the day. If you damage your skin or have a flare-up of a skin condition between your pre-operation assessment and your treatment, it is vital that you seek advice from us.
  • Please shower or bathe before coming to the hospital. Makeup, false eyelashes or body lotions should be avoided as they prevent heart monitor pads and dressings from sticking properly. Please remove nail varnish and ask for advice about false nails. This is because a pulse oximeter, a small clip-like device is attached to your finger to measure the oxygen saturation in your blood.  Please tie long hair back. Refrain from applying fake tan for a period of 7 days prior to you surgery date.
  • You should remove jewellery and/or any decorative piercings ideally before you go to the hospital. If you cannot remove it, the nurses will cover it with tape to prevent damage to it or to your skin. A wedding ring can usually be worn. It is important to remove any piercings around the lips and tongue before an anaesthetic to prevent difficulties and injury from the equipment used to look after your airway and breathing.
  • Please wear loose fitting clothes and comfortable shoes so that you can change easily before and following your surgery.

Pack a small bag with the items you need on the day

  • All your medications including inhalers (general Anaesthetic procedures only).
  • Glasses/contact lenses.
  • Appropriate, comfortable clothing and shoes. If you’re having Breast surgery, bring a zip/button-up jacket or top as you may not be able to lift your arms over your head.
  • Hair bobble (non-metal).
  • You may also want to bring a book, magazine, or tablet to help pass the time. Guest Wi-Fi is available. Please bring your charger.
  • A small bedside locker is available for personal possessions. As storage space is limited, please only bring essentials.

If staying overnight, you may also wish to bring

  • Cosmetics including roller ball deodorant, baby wipes, toothbrush and toothpaste, dry shampoo.
  • Dressing gown and slippers (some patients get cold or like the comfort of personal items).
  • Snacks (drinks and light meals are provided but in case you want more).

Fasting before surgery

During Sedation and General Anaesthetic it is essential that your stomach is empty for your own safety, as there is a risk of stomach contents coming back up your throat and entering your lungs.

For you to stay adequately hydrated we advise the following:

For all General Anaesthetic & Sedation procedures:

6 Hours before admission time

  • Stop solid food, milk, sweets or chewing gum, tea/coffee with milk
  • Continue to drink clear, still unflavoured water, tea/coffee without milk
  • Continue to take prescribed medication

2 Hours before admission time:

Stop drinking water, all tea/coffee and all medications (unless instructed otherwise by your nurse or consultant.

Day surgery staff will inform you if you are allowed any further clear fluids once you have arrived at the clinic/hospital.

If you have diabetes or have concerns about fasting, please contact your consultant or nursing staff. Your diabetes must be stable in order to proceed with the planned operation.

For all Local anaesthetic procedures

You do not need to fast before your procedure. Please have a light meal up to two hours before your admission time. Continue to drink fluids.

2. Day of Surgery

Most of our surgery procedures at The Private Clinic do not require an overnight stay and are performed on a day-case basis. This means you will return home (or to a hotel) on the same day as your surgery. 

Hospital Admission

When you arrive at the hospital a member of the reception team will greet you and your personal details will be checked and confirmed.  You may spend a short time in the reception area before being admitted.  One of the clinical team will meet and escort you to your allocated bedspace or admission room and complete the necessary checks, observations and safety questionnaire.

Once you have been admitted to the unit by your nurse, any relatives, friends or escorts will not normally be allowed to remain with you during your stay; however, they may wait in the reception area should occupancy allow this. Your admitting nurse will provide your chaperone with an estimation of the time you will be ready to go home to allow them to plan your transportation needs.

You will be asked to wear a cotton procedure gown and, in some cases, disposable underwear. Please let the staff know if you are required to keep your head covered due to religious beliefs.

Jewellery, body piercings and contact lenses must be removed before entering the theatre, though you may however keep your wedding ring on – this will be covered with tape. Please do not bring other valuable items with you.

Hearing aids and dentures will be left in place.

Your anaesthetist and surgeon will see you prior to transfer to the operating room to discuss the procedure, anaesthesia, and sign consent forms. If you are having an operation on a particular part of your body this may be marked with an arrow or other markings may be made by your Surgeon.

Meeting your anaesthetist

On the day, you will meet your anaesthetist in the pre-operative area before surgery. Your anaesthetist will explain what is going to happen and you will be given the opportunity to ask questions. Risks and complications will be discussed with you, and you will be required to sign a document to give your consent for anaesthesia. One of the Operating Department Team will transfer you to theatre and introduce you to the team prior to administration of required anaesthetic.

Before & during anaesthesia

Just before you have surgery, you’ll usually be taken to the operating theatre where your anaesthetist will give you the general anaesthetic. 

Anaesthetic will be given as a liquid that’s injected into your veins through a cannula (a thin, plastic tube that feeds into a vein, usually on the back of your hand). The anaesthetic should take effect very quickly. You’ll start feeling lightheaded, before becoming unconscious within a minute or so.

The anaesthetist will stay with you throughout the procedure. They’ll make sure you continue to receive the anaesthetic and that you stay in a controlled state of unconsciousness. They will also give you painkilling medicine into your veins, so that you are comfortable when you wake up. There will be an Operating Departing Practitioner to assist the anaesthetist throughout the procedure.

Your surgeon will perform your surgery supported by scrub staff and assistants.

After your operation, the anaesthetist will stop the anaesthetic and you will gradually wake up.

Immediate Recovery & Discharge

You will initially be cared for in the Stage 1 recovery area. You may feel drowsy at first and drift off to sleep. You may be aware of other patients in the recovery area and the noise of the monitors beeping. As you become more alert, staff will sit you up and talk with you.

Staff will usually provide you with oxygen via a mask or soft tube that sits under the nostrils. Staff will monitor your vital signs (blood pressure, pulse rate and temperature) and ask how you are feeling and treat any pain or sickness you are experiencing. You may feel cold and shivery (a normal response to anaesthesia) and will be given blankets to warm you quickly. Staff will regularly check your wound site to ensure there is no bleeding. You will be encouraged to drink, and sips of water will be offered as soon as you are able to talk again.

Once the nurse looking after you is happy you are awake, comfortable and stable, you will be transferred to Stage 2 recovery. Here, you can rest and relax and have something to eat and drink. Staff in stage 2 will help you mobilise, dress and will let your chaperone know when you are likely to be ready to go home. Depending on your circumstances, you will usually need to stay in hospital for a few hours or sometimes for an overnight stay. If staying overnight, you will be provided with a private room, and cared for by our clinical team, until discharge the following morning.

The Surgeon and Anaesthetist may visit you in the recovery area to let you know how things went during your operation and to check how you are recovering.

Our nurses will provide you with any post-operative guidance and medications prescribed by your surgeon to take during the following week to aid your recovery.

You will have dressings applied to the area that has been treated. An appointment will be made for dressing change, and a check of the wounds within 14 days post-operatively.

Our team will ensure you are well enough to leave the hospital and understand all of our instructions, prior to discharge. You and your chaperone will be provided with a written copy of the instructions including caring for your surgical wound and information regarding DVT prophylaxsis.

Following general anaesthetic or sedation you should be driven home and accompanied by a responsible adult. You will need someone to stay with you for 24 hours following your procedure, as your judgment may be affected. You may experience nausea, vomiting, drowsiness, and dizziness and need to help you with bathing and dressing, cooking etc during that time.

We advise that you do not undertake any of the following for 24 hours:

  • Driving (as this may invalidate your insurance).
  • Operate machinery.
  • Put yourself in potentially dangerous situations (eg; climbing a ladder).
  • Carry or look after children.
  • Drink alcohol and/or eat a heavy meal.
  • Smoking (or for as long as advised by the treating surgeon)
  • Sign documents or undertake responsible business as your decision-making may be impaired.

3. Aftercare & Post-operative Recovery

A comprehensive post-operative care service is provided for you as part of your aftercare package. Please follow the post-operative instructions given to you by our team and remember our ‘Out of Hours – on call service’ is only a phone-call away should you have any concerns post-operatively (Tel: 0333 920 2649).

It is important that you allow yourself sufficient time for recovery. Rest is clearly important to this process. However, it is vital that you remain relatively active following your operation, but vigorous exercise and labour-intensive work is not recommended.

The morning following your surgery, you will be called by a member of our nursing team to check how you are feeling following your first night, check you are following the post-operative instructions and answer any questions you may have.

Review Appointments

It is essential to your recovery following surgery that you attend the scheduled post-operative appointments with both the out-patient team/clinic team and your Surgeon. The number of post-operative appointments will be determined by your own recovery, and should you experience a complication we may need to see you more regularly in clinic or we may need you to go re-visit the hospital.

Post-operative review appointments with the clinic nurse will be provided in line with the post-operative care regime for your procedure, or as your recovery dictates. No further appointments are required unless clinically indicated. Review appointments will be provided with the surgeon who performed your surgery, please note that it is not our policy to transfer the care of patients to a different surgeon except for in exceptional circumstances and as agreed with your surgeon. Review appointments with your surgeon will be provided in line with the post-operative care regime for your procedure, or as your recovery dictates.

4. Providing Feedback

Your feedback is important to us; we will use it to celebrate what we are doing well, share learning, replicate successful initiatives where appropriate and make improvements where you think we could do better. Feedback regarding your experience with us will be requested at point of discharge. A QR code provided should you prefer to complete this at home.

You will be invited to participate in our patient survey pre-operatively, and again approximately six months post-surgery. Results of the surveys not only help us to gain an overall understanding the success of your surgery but help to influence improvements in our clinical practices and service delivery and enable us to provide honest and transparent information to prospective patients considering surgery.

Our regulators, the Care Quality Commission are keen to receive feedback directly from patients regarding their experience too, albeit good or bad, to better understand the quality of care received at The Private Clinic. Feedback can be provided through their website.